Fitness & Energy Blackmores Sydney Running Festival

Hi Brad,
I have been diagnosed with Hamstring origin tendinopathy.(45yr old woman, only running 12mths-fairly common i'm told). I've had a cortisone injection in it 1 week ago and am wearing a groin strap when running(seems to help especially up hills). Could you recommend any strengthening exercises or anything else to help.Thank you.

Hi Lou, what you're describing is a common problem when getting back into running after a break, and I think there is something to the compensation argument. We often see sore muscles and joints lead to other sore muscles and joints! Try these simple strategies, and if your legs continue to trouble you, have a chat to your local physio - you might need to give some attention to your running style, your pelvis and your core muscles:
1) warm-up by walking for 5 minutes and then gradually ease into your run.
2) gently stretch 'after' your run, not 'before'. There's some evidence that this may be a better strategy for injury minimisation.
3) keep your runs flat to begin with. This will decrease the loads through your quad and hamstring. You've still got a good chunk of time before the event, so you can afford to build your base with some flat running at the moment.
4) deep-water running with a flotation belt gives you a way of exercising the same muscles as you do in land-based running without the overload. It's also an awesome workout!
5) try a topical heat rub to the affected muscles before you run. This isn't nearly as good as a gentle warm-up, but might help a bit with the stiffness.
6) most importantly...keep going! Even if you can only run a few minutes before you notice the quad or hamstring, this is better than no running at all. Use this as a base to build your training on.

Good luck!

Brad

Hi Paul,

It sounds as though you have ITB Friction Syndrome, one of the most common running injuries and certainly the most common cause of outside knee pain. It comes on at about the same point each run, and you generally can't run through it as it gets VERY sore! The problem is biomechanical as the ITB 'flicks' over the outside of the knee and becomes irritated.

The main problem is with your butt! Shoes and orthotics have been touted as a fix for ITB friction syndrome, but I'm not aware of any good research on this and think it's primarily anecdotal. The mainstay of treatment is gluteal strength/endurance training and correcting your running biomechanics. Running up to, but not beyond, the pain is important too, as they tend to come on sooner after you rest for a week or two. I like to treat ITBFS quite 'actively', maintaining a running program but perhaps temporarily decreasing the mileage.

If you send me through an email (bradmcintosh@ssop.com.au) I'll fire you an article I wrote on ITB Friction with some more info. It's actually an enjoyable problem to treat in runners, as when you treat them well you can have some spectacular results. When left to its own devices, or treated poorly, it can tend to linger on and on...

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Ros,

The most likely scenario is a painful exostosis or 'bony bump' where the 1st metatarsal bone meets the medial cuneiform. You can try lacing the shoe more lightly, or trial a broader running shoe, however you need to correct your biomechanics to properly treat this problem. This might include calf stretches, changing your running mechanics and/or orthotics. Have a chat to your physio or sports podiatrist to help you with this.

It's unlikely, but bone stress can also cause pain on the top of the foot in runners, so it might be best to head in and get it looked at.

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Anthony,

This is a difficult one to say without assessment - it would require a thorough look at your hip/pelvis/lumbar spine (and overall) biomechanics. Paraesthesia/burning are suggestive of a neural (nerve) component/irritation in this region.

As general advice, I would be looking at what postures/positions/activities you are doing daily. Is there anything there that may be lending to a left sided problem? For example sitting at your desk, crossing legs or twisted to one side. Address this first and evaluate anything you may be doing during the day which might be contributing.

Secondly, is there anything about your running that you think might be contributing? Also look at the surface of the road that you are running on - is it always one side with a camber so that left side is relatively compressed etc. Make sure that you are varying your runs and see if this helps.

Often we see low back/pelvic/hip issues in runners associated with an underlying reduction in core strength/stability, and it often ties with hip biomechanics. Gluteals and core musculature are regions which tend to be implicated in runners with this type of issue as these provide stability for this area - it may be that a strength programme may be required.

Please let me know if you'd like any further advice - but it may be worthwhile having a proper assessment to help you determine these factors.

All the best,

Brad.

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Elizabeth,

Retrocalcaneal bursitis is common in athletes and can be difficult to settle. Biomechanical factors, ankle/midfoot joint stiffness, and muscle tightness of muscles higher up e.g. calf can all contribute, as does the control of muscles around the foot/ankle and up higher. It may also coexist with Achilles tendinopathy.

A dynamic warmup including calf musculature, which may involve eccentric control through the calf/Achilles tendon, for example heel lowers from a step, may be more effective than static stretches alone. It would be important that this were not painful, however.

If your symptoms appear inflammatory - i.e. stiff and sore in the morning after a run for longer than half an hour, and particularly sore at night, then it is important to reduce the inflammation by a relative period of rest/ice/anti-inflammatories as indicated. Icing the area following a run may help e.g. ice wrapped in damp towel, every two hours after.

As a general guide, wear a footwear that is comfortable and feels like it provides adequate support for your foot - as not all shoes will suit everyone. Feel free to read a blog I wrote earlier on our website www.ssop.com.au" target="_blank">www.ssop.com.au about selection of footwear. It may be worthwhile discussing this with your physio or podiatrist.

I hope this helps guide your query,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au" target="_blank">www.ssop.com.au)

Hi Michelle,

Tape can be an excellent means of facilitating the desired control and supporting knee structures via means of proprioceptive feedback. There are several taping methods which could be appropriate for your knee to achieve a desired effect. It sounds like potentially after a particular distance your body may be fatiguing which can make an underlying injury or biomechanical fault susceptible to increased stress. There are also newer tapes such as kinesiotape which can also be quite effective here. You would want to discuss with your local physio your problem so they may guide a taping strategy specific to your needs.

There is some evidence for glucosamine supplements in preventing early joint degeneration - I am unsure if this is your problem, but if you are concerned, you would be best to discuss this with your local GP.

All the best!

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Steve,

There is some evidence to suggest that contrast baths (alternating heat and cold) and ice baths may help recovery - due to the effects on reducing microinflammation in muscle and therefore incidence on DOMS, as well as the metabolic effect.

I am not aware of any set protocol, and I would think this would depend on the length of your run etc. Some leading football (AFL) clubs will do a cycle of 3 sets of 2 min cold, 1 min hot, for 3 cycles. The depth of immersion should be targeting the major muscle groups worked during the exercise. Please take caution immersing past chest particularly if you have a heart or other condition.

Evidence suggests that a dynamic warm up and cool down may be more effective than static stretching alone - unless you have particular area/injury that needs stretching. However, everybody has different collagen makeup and may respond to static stretches differently.

Good luck!

Brad

Hi Kate,

Sounds like you have an interesting problem. It's really hard to give a formal diagnosis without physically looking at your foot (and indeed your entire biomechanical lower limb chain).

If you have been running more than usual it could be that you are starting with some peroneal tendinopathy as the insertion of the peroneal tendons is into the cuboid bone near the base of the 5th metatarsal head. Tendon problems often 'warm up' and pain settles with activity, so I would exclude this as a problem first.

Worth a trip to your local physio to get a formal diagnosis, but I would recommend not pushing through the pain and ignoring it at this stage.

Have a look at this post on our website about tendinosis, ssop.com.au/common_injuries/body_parts/muscles,_tendons,_ligaments/tendonitis/tab0010/menu010. Hopefully this will give you somewhere to start.

Good luck with getting to the bottom of the problem

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Taylor,

The most likely diagnosis is patellofemoral pain syndrome (also called anterior knee pain syndrome). This is most easily described as the kneecap joints not tolerating the forces that you're putting through them. Things like downhills and downstairs are fairly high load activities for kneecaps. Usually, there are some key biomechanical or movement problems and one of the most common issues is with the hip joints. It is VERY VERY hard to dislocate a hip joint, but it sounds as though they are a part of your movement problem.

We see this quite a bit in teenage girls, and it is manageable. The important thing to remember or understand, is that there is nothing structurally wrong with your knees. We just need to stretch a few things and strengthen a few others to enable you to move a bit differently. Taping the knees will also help a lot in the short term.

It's also possible that your knee pain is actually coming from your hips. Again, we can see this occur sometimes in teenagers, but it is unlikely. I'd recommend you go and see a good physio or sports physician near you to get this diagnosed and managed. You sound active, which is great, so the sooner you get on top of things the better and the less likely you are to have to rest from your sports and activities.

Let me know if you have any further questions - bradmcintosh@ssop.com.au

All the best,

Brad

Hi Rachell

Shin splints can be a real problem for runners (as I'm sure you are aware).

If you are still getting problems even with the orthotics in, it may be time to look at the whole lower limb biomechanics. Underactive core and gluteal muscles can potentially lead to overloading of the muscles of the lower leg resulting in shin pain.

If you are doing a dynamic warm up (walking on heels/toes, heel drop off step walking etc..) and have tried to keep your runs short to avoid pain and are still having issues, I would recommend getting a physio to screen you to see if there is an underlying biomechanical cause. Some physios have video analysis software that can assess you dynamically (i.e. while you are running on a treadmill), that would be the gold standard assessment.

Hope that helps a little

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Tim

I agree it does sound like golfers elbow (also known as medial epicondylalgia).

It can be from a small tear in the common flexor tendon where it blends into the bone.

Most tendon tears benefit from a combination of regular icing (for 20 mins) 3-4 times a day and eccentric strengthening.

You can try a counterforce brace (a simple wraparound strap used in tennis elbow rehabilitation) but if it doesn't work fairly quickly I wouldn't persist using it.

I would try these things first and then see how you go over the next few weeks.

Hope this helps

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Subacromial bursa impingement syndrome causes inflammation of the subacromial bursa, which yes, can be quite painful.

In order to understand what's going on in your shoulder, I'll explain some of the anatomy. You may have heard of a group of muscles called 'the rotator cuff' muscles which provide the stability in your shoulder. Bones and ligaments form an arch over these muscles, creating 'the subacromial space. This space is then filled with the subacromial bursa, a sac of fluid designed to prevent friction of one structure on another.

A common cause of subacromial bursa impingement syndrome is shoulder instability. This can occur due to repetitive overhead activities with poor control of your shoulder blade and arm. This results in the rotator cuff overworking and eventually becoming tired. Once this happens, the shoulder loses the good rhythm it requires to maintain the subacromial space, and the subacromial bursa, can then become squashed, leading to the pain that you're feeling.

Initially, icing the shoulder can help to try and bring down some of the pain and inflammation. Avoiding pain provoking activities is also a good idea at this time. Once things have settled, physiotherapy can help restore the control the shoulder blade has lost. Stability is essential before moving onto strengthening and this can be achieved with a simple exercise program. Once this is achieved, you would progress onto strengthening and more functional exercises.

So, getting on top of the shoulder blade control, with specific exercises shown by a physio, should help with your problem.

I hope this helps!!

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Shirley,

It is obviously difficult to say exactly what is wrong with your knee without getting a full history and examining it.

However, you say you are carrying out exercises to strengthen the knee but are they the correct exercises?

Your knee is not only supported by the muscles in your thigh, but also relies heavily on the muscles in your butt, your glutes. Their strength and control are highly important in the control of the knee.

Grinding of the knee is usually caused by mal-tracking of the knee cap over the lower part of the thigh bone as you bend your knee. This can be due to weakness in certain muscles and tightness in others.

Generally, improving the strength and endurance of the stability muscles in your thigh and butt and loosening out the over-worked muscles will help your problem. If you shoot me through an email, I can send you on some exercises to get you started.

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Peter,

Tennis elbow is a difficult problem to manage and can be recalcitrant. Eccentric exercises (the lowering exercise), bracing or taping, and consideration of the contribution of your neck and shoulder blade are the cornerstones of conservative management. Even when instituted well, things can be quite slow to improve, but rest assured that it will get better.

There have recently been 2 studies on the positive effects of the addition of platelet rich plasma (prp) injections in people with tennis elbow that isn't responding to appropriate physiotherapy. If you feel you have done everything right, as advised by your physio, it might be worth having a chat to him or her about the addition of prp injections at this time. Go to: http://www.prpinjection.com.au for more information.

Just remember that the prp isn't a cure all. It may help, but ultimately you need to keep doing the eccentric strengthening exercises to get the tendon back in good shape. Good luck, hang in there as it will get better, and let me know if I can assist further.

Cheers,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Emily,

As there are many problems that can create this scenario, and the advice is quite different for each, could you give me a ring on 9252 5770 so we can discuss in a bit more detail? You may have to leave your number if I'm in with a patient, however, I'll give you a ring back as quickly as possible.

Many thanks,

Brad

Hi Jo,

The most appropriate exercises would best be determined by a physio assessing you in person, and will depend on what stage you are at in your recovery, the exact type of fixation used, your age and general health.

For a general reference, you can check:

www.northdevonhealth.nhs.uk/.../...s_fracture.html

This is quite a good description of the general principles of rehabilitation of a Colles fracture. Let me know if I can help any further - bradmcintosh@ssop.com.au

Kind regards,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Jo,

The most appropriate exercises would best be determined by a physio assessing you in person, and will depend on what stage you are at in your recovery, the exact type of fixation used, your age and general health.

For a general reference, you can check:

www.northdevonhealth.nhs.uk/.../...s_fracture.html

This is quite a good description of the general principles of rehabilitation of a Colles fracture. Let me know if I can help any further - bradmcintosh@ssop.com.au

Kind regards,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Jessie,

This is a little difficult to say specifically without assessment of your low back/pelvic/hip region.

If you are experiencing short term benefit from manual (hands on treatment) then it would be a matter of working out why the effects of treatment were not being sustained. Potentially there could be a work/postural habit perpetuating the issue. Often there is an underlying weakness, which may be related to your core (inner unit of abdominal/pelvic musculature) and/or hip stability/strength.

Though you do have a structural anomaly in terms of your fused vertebrae/sacrum, this does not necessarily need to be painful, and it would be worthwhile having a qualified health professional assess your movement and strength to see if this may be contributing to your symptoms.

Exercises would need to be tailored for your function. For example if you run regularly you need good core stability and gluteal strength in order to support your low back for directional/compressive loading. Clinical Pilates is one means of achieving this type of control so that your low spine/sacrum (tailbone) are supported for movement.

If you'd like further info please refer to our website which has details regarding the benefits of Pilates/core stability exercises. Please let me know if you'd like any further advice - but I do think it would be worthwhile consulting a phyiso prior to undertaking an exercise-based regime.

All the best,

Brad


(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Matt

What you are reporting is quite usual with lateral ligament strains. The tenderness over the bone is from the ligament pulling away from the fibrous periosteal covering of the bone. This should reduce given time, the periosteum is highly innervated so thats why it is so sore to touch.

As the ligament heals by fibrosis (the laying down of scar tissue) and the scar matures the collagen fibres in the scar shorten leaving the joint feeling stiff. This can also last for a few more weeks yet.

Keep moving, keep stretching the ligament and start cycling/swimming and light walking to keep up your fitness. Strapping may help you in the early stages when returning to impact exercise.

Balance exercises are also commonly overlooked in the rehabilitation phase too, so start balancing on one leg whenever you get a second, or use a wobbleboard at the gym.

Most ankle strains take 3 weeks to feel 100% if the strain was minor. I would start to think about a light jog over the weekend with your ankle taped and see how your ankle responds. If you are nervous or it doesn't continue to improve a physio assessment would be the next logical step.

Good luck with it

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Brad,

Thanks for that info.

I have been to a physio who gave some exercises to do, but the doctor didnt allow me to anything resistant so there wasn't alot i could do. I went back I to the gym to my cardio class about 2 - 3 weeks and the punching doesnt seem to bother it all, my forearm just goes red but i think that is just because i have used it for a few weeks.

I have been doing the exercise still and also have been massaging it. The muscles are still very, very tight especially in the forearm and my bicep area, my arm isn’t 100% straight.
What can I do to help straighten it and loosen the muscles, if i put my palm up facing my face the muscles on the left are the ones that are very tight and sometimes very sore aswell.

Hi Glenda,

Achilles tendonopathies are common in runners, and benefit best from a sound assessment which will also include addressing your biomechanics to see if this may be contributing.

It is difficult to advise specifically without assessment of both of your Achilles and discussing with you their pattern of soreness. Achilles tendon problems range from varying stages of inflammation and stage of tissue healing - so the appropriateness of eccentric exercises for your Achilles will depend on the likely process occurring in the tendon. A physiotherapist can help assist in this regard.

If the Achilles are sore because of acute inflammation, the best management for this is to relative rest the tender area from activities causing the trauma. Stretches for the calf, heel inserts, orhotics and modifying your activity e.g. reducing your running or complete rest from running, may help offload tension from the painful Achilles area as a short term solution.

As the inflammation subsides, then the tendons require targeted eccentric exercises (tendon lengthening during contraction) to assist in tendon tissue repair. As a general rule, this should not be painful in order to avoid reaggravation of the tissue - and there are ways to begin modified eccentric exercises early so as to not do too much too soon.

Chronic tendon pathology may require slightly different management, but it is best to consult your local physio to help get you on the right track.

Please refer to our website on tendon healing at ssop.com.au/.../menu09

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Ingrid!

I'm sorry to hear that. Sounds like you are being very proactive in terms of your nutrition to boost your fracture healing along!

I am not sure whether or not you have been told to fully weightbear so it is difficult for me to advise in this regard. Even simple ankle fractures can take at least 6-8 weeks to heal, which will influence how much weight you should be putting through your foot. Your ability to weightbear will therefore depend on:

- your type of fracture e.g. simple, comminuted, location, size, complexity, joint involvement etc., plus your overall bone health
- your pain levels
- your strength, mobility and stability of the muscles, tendons, ligaments around the joint, plus functional balance/control/proprioception
- overall fitness/strength
- your activity demands - e.g. sitting at an office versus on your foot all day for work

If you are having trouble getting in touch with your physio then I would advise to ring your orthopaedic specialist and check how much you are allowed to safely weightbear in terms of your fracture, and get some general advice from him. If you are weightbearing as tolerated then it would be best to gradually increase your exercise tolerance on your ankle such as graded increase in work hours. It would be best to follow up with a physio as soon as possible or check with someone else in the clinic.

Please let me know if you have any further concerns.

Best wishes,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Sandra,

I am sorry to hear of your ongoing problem. It is somewhat difficult to advise without knowing your type and location of hernias in the past e.g. whether they have been direct or indirect, located in the inguinal or femoral canal. There may be predisposing variables as to why this has occurred.

Your inguinal and femoral canal is significantly influenced by the fascia and muscular support of the structures surrounding them. This includes particularly your abdominal musculature - obliques, rectus abdominals and transversus abdominals which have particular actions on your inguinal ligament, as well as pelvic floor and hip musculature and fascia (connective tissue).

For this reason, it is recommended to maximise your abdominal/pelvic/hip stability to minimise any excessive stress on your ligamentous structures. Exercises would need to be tailored to your specific needs and take into account your biomechanics of this region. It is unclear whether the soreness you are experiencing is secondary to your hernia, or may be related to an underlying weakness or muscle imbalance. What you are describing in terms of soreness with exertion i.e. increasing intra-abdominal pressure can be typical of a herniated site. Potentially improving the recruitment of abdominal musculature may assist in some of the symptoms you are experiencing.

It would be best to follow this up with a physio who may set you on the right path.

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Jeni,

There are several structures that can create soreness of your heel region.

From what you are describing it sounds like you may be experiencing pain as a result of plantar fasciitis, which is fascia at the arch of your foot; a problem common to runners. This can occur if the fascia is continually overloaded. This may be due to several variables including muscle imbalance/weakness/tightness around your foot/leg or ankle, overpronation and innapropriate footwear and/or training. Neural tissue can also either be a source or contributing factor towards pain at this site.

Commonly it can occur with tightness of your calf/Achilles region, or ankle joint (subtalar joint) stiffness. A physio may be able to assist with manual treatment/massage of your plantar fascia, calf and mobilisation of these joints.

It would be then important to address any underlying biomechanics - if you are cramping with your orthotics, potentially your intrinsic foot musculature works harder in these, or you are getting too much tension on your fascia prior to toe-off.

Try a good dynamic warm up for your calves e.g. heel drop off step, self massage through calf and plantar fascia (though not if it creates more soreness), and an initial reduction in running intensity towards gradually rebuilding your distance at which you can run without worsening soreness.

Otherwise, may pay to see a physio to check if there is any imbalance that some strengthening exercises may assist in improving - e.g. the muscles that support the arch of your foot.

For further information, please see ssop.com.au/.../menu09

Best wishes,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Emma,

Congratulations on your first half marathon completion.

It is very important you resume your gluteal strength exercises as soon as possible in order to build good support for your knee and ankle/foot, if this has been a problem in the past. The likelihood of this problem returning once you resume training depends on how well you have developed your gluteal control/strength with your exercise regime, and you would want to consider initial reduction of your load i.e. distance and the pace of your runs within comfortable limits for your patellofemoral joint.

As a general rule, stress fractures will take around 6 weeks to heal and need relative rest from activity. It is very important that prior to resuming increasing load through your foot that any biomechanical reason for possible increased load at that part of the foot is addressed. With some fractures e.g. navicular this healing time can be longer due to poor vascularity. Depending on the fracture type and location e.g. if a tendon has been continuously pulling at the fracture site, then timeframes for getting back to sport can be longer.

I wish you all the best - it sounds like it would be worthwhile following up with your physio asap and bring the scans with you so that they may set you back on the right track and advise further in this regard. There are exercises you can do whilst the fracture is healing (if it is a fracture) to maximise your cardiovascular fitness and overall strength to minimise length of time from your sport.

Good luck,

Brad

Hi Col,

I am sorry to hear of your difficulties in the past.

It sounds like you may benefit from a review by your GP or neurological physio if you are noticing a recent change in terms of your function. If it is only recently that you are having more difficulty with your right side then this would benefit from assessment. Potentially targeted exercises for balance/coordination, right-side awareness ('hemineglect') and overall strength/mobility, as advised by a neurological physiotherapist, may be the underlying solution.

It is difficult to suggest for your hip without thorough assessment - and the throbbing is an unusual description which too may benefit from a quick check at the GP.

If the left side is compensating for the right, then I would consider addressing a few things:

1. your overall technique for riding, setup of the saddle etc. - is there something that could be changed to assist your specific areas of strengths?
2. modifying/monitoring your overall length of time on the horse, breaks etc.
3. strengthening the muscles around the left hip to help promote good stability.

It may be that you are relying heavily on your hamstrings/hip flexors/adductors, which could indicate technique issues, or imbalance of strength for example insufficient gluteal strength. Try putting your weight through your heels on the horse and pushing up using your bottom, or changing your trunk lean. Supported squats, sit-stands from a chair etc. could be exercises to help here. Assessment from a musculoskeletal or neuro physio may also help suggest specific exercises.

All the best with your riding!

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Gavin,

It sounds like you may be experiencing iliotibial band friction syndrome - a problem common to runners. This can occur due to excessive friction of the iliotibial band over the lateral epicondyle of the femur, and or excessive compressive forces of the iliotibial band over the bursa on the outer part of the knee.

This tends to occur when there is excessive contraction through this structure or improper biomechanics lending to overuse at this area. Often other factors e.g. road surface or training errors contribute.

Support such as taping may assist in reducing the load at the outer part of the knee, however without addressing the biomechanics contributing to this, potentially this problem may reoccur.

It would be worthwhile discussing with your local physio some exercises for your gluteal control/strength because frequently this is an area of weakness needing a targeted programme.

For further information on this please refer to our website article at ssop.com.au/.../menu08.

Good luck!

Brad


(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Berlin,

This sounds like a difficult issue for you. Try changing your run so that you can may to increase your total distance. For example reduce your pace, run on the flat or a less difficult course. If you have reduced your running intensity and are still experiencing this problem, try walking for part or the remainder of the distance you are trying to achieve. Or walk:jog intervals.

Without knowing the rest of your running programme it is difficult to advise further, however having a rest day or reducing the length of the run prior to your 16km run may help.

Otherwise I would have a running assessment with a physio to ascertain why you may be experiencing targeted soreness in these areas.

Best wishes,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Leah,

The aggravation in the knee can be a number of things, but there are two likely scenarios in this case:

1) because you had a patellar tendon graft for your reconstructed ACL, your chances of developing some anterior knee pain are increased, even this far down the track. Check out:

ssop.com.au/.../menu08

for some more information on this condition.

2) given that you've had a pretty good run with the knee and it was flared up by netball, rather than running, it is always possible that you have an area of 'weak' cartilage in the knee from the original injury. This is very common. Not a bad scenario if this is the case, just give it a chance to settle down with some short-term rest and ice, strap it up and get back out there as soon as it feels ready. Oh, and maybe think about giving the netball a miss if the marathon is a higher priority?!

If the knee swells and continues to be sore after activity, it could be worth getting it looked at to determine if there is some 'wear and tear' as a result of the initial injury. The only reason I mention this, is that it may guide your future running plans a little. We know that doing a lot of running kilometres on a knee that has had an injury such as an ACL rupture, can lead to early osteoarthritis (I say this not to worry you at all(!) but just so you can keep it in the back of your mind).

If you're in Sydney, pop in and see me and we can work it up and set you on the right path.

All the best,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Tracey,

Glad you've started running again! It's not uncommon to get some pains and niggles when starting up after a reasonable break, but could you give me some more information on your hip pain?

For example, describe where it hurts, how much pain you have and during what activities/movements, what you do to make it feel better, if you've ever had any problems there before, roughly how old you are and what your running goals are.

Look forward to checking in on your next post...

Cheers,

Brad

Hi Bronwyn

Sorry for the late reply!!

Sometimes following abdominal surgery the deep muscles can loose a little motor memory, forgetting the job they are designed to do. This can result in you compensating and overloading other structures, which then break down with increasing training.

Just restarting running is sometimes not enough to remind the deep muscles how to function and you may need to see a physio and learn how to cue your deep muscles in order to 'jog' the muscle's memory.

That being said you were only sore for 3 days after the run, which may mean you were suffering severe DOMS (delayed onset muscle soreness). This is a normal response to a change in muscle loading and although you had a bad episode this time, your next run should be less sore.

It may be worthwhile you learning how to cue your deep muscles AND phasing up your distance/speed a little more slowly in future. But if you pull up terribly after your next run I would get yourself properly checked out before committing to more running.

Let me know how you go

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi L,

It is difficult to say without assessment of your knee and you may need to give me a little bit more information as to your knee problem i.e. where the pain is, what activities hurt, what activities ease your symptoms etc. It's hard to advise without knowing what structures are involved and your biomechanics.

Feel free to send through some of these details - I would be more than happy to try to offer some more suggestions.

Kind Regards,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Alice,

It is best to start with a dynamic warmup involving all your leg muscles prior to the run. This could include a light jog then dynamic exercises such as lunge-walking, heel kicks, heel drop-off steps etc. For further information please refer to our website at http://ssop.com.au/ which has a recent blog discussing this.

Then, depending on your areas of tightness it may pay to do a series of static stretches of major muscle groups e.g. gluteals, hamstrings, hip flexors/quadriceps and calf muscles. As you become familiar with this as a routine you will begin to notice which areas tend to get more tight with your running.

If you have sciatic nerve problem on right side you will need to be particularly careful with hamstring and gluteal stretches to maintain a normal low back curve - best performed laying on your back to stabilise your spine - and not do the stretch into any discomfort. The location of your sciatic nerve irritation will determine the stretches/exercises with which you will need to exercise caution.

Good luck,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Kevin,

I'm sorry to hear of your recent injury.

There are specific exercises for calf tears that you should commence as early as possible in order to strengthen the calf muscle and assist good repair through the torn area. Chat to your local physio and they may be able to advise what level of calf strength in the form of theraband, raises etc. are most appropriate depending on the size and location of your tear.

For cardiovascular fitness you may be able to try cycling or swimming (low impact) at a higher intensity. If you have access to a pool you could also try water jogging at a depth that is comfortable for the calf, and progressively move to more shallow depths. Make sure you are not feeling any tightening/cramping through the injured area or surrounding calf.

Ensure that you progress your calf exercises to include exercises for power (increased speed) as well as endurance - as it is important that the muscle acheives this to minimise any chance of reinjury.

All the best with your rehabilitation,

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

thats ok

Hi Taija

Overtraining is only one reason for developing stress reactions. There are also medical reasons as to why someone may be prone to stress fractures. For example polycystic ovarian syndrome, osteoporosis and long term prednisolone use can predispose people to stress fractures too.

You are 28 (therefore definately NOT old!) and so you shouldn't be feeling old.

I think your best strategy is to be systematic. Firstly correct any biomechanical factors that may predispose you to stress reactions (such as weak core or gluteal muscles or tight calf muscles for example). To do this you should go see a physio who can look at your running style and test to see where you should start.

Secondly a referral to a good sports medicine doctor (your GP should be able to do this for you) to check there is not a medical reason for your problems, and also to confirm with a bone scan as to whether this is indeed a bony injury.

Lastly when you are sure your are medically and biomechanically sound, then gradually increase your training load.

I hope this helps you.

Brad
(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Marianne

The most important thing right now is to settle the acute reaction. You are wise to rest for 3 days and ice and possibly look at compression also (skins etc work well, especially the long leg ones).

Light walking within painfree range should maintain the contractle tissue nicely over this time. Gradually extending the stride lengths over the next few days BUT stay inside your pain threshold.

You are better to err on the side of caution with regard to resuming training. It is fine to go into a race a little underdone (the glory of the adrenal response should pump a few seconds off your time anyway!! - especially if your lead up work has been good). But to push to hard too soon is risky as restraining is very common in the early rehab period.

Listen to your body with regards to returning to training. Gradually increase your walking until you are at a jog, then carefully start striding out. Light dynamic hamstring stretches should be started at day 5, and hamstring strengthening can start in earnest from day 10 (focus on eccentric training like painfree small range Nordic hamstring curls/Romanian deadlifts and then progress over time).

It will be ok if you DONT push it too fast. Be patient.

I hope this helps you.

Brad
(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Trish

The reason for your pain could be one of many things. It helps to have more information for me to give you better advice.

You would definitely benefit from being reviewed by a good physio so that they can figure out the cause of your problem and advise you accordingly. If rest alone isn't working it is worthwhile getting it checked out.

If there is point tenderness at the base of the kneecap it could be that there is some patellar tendinopathy, if it's more vague it could be a kneecap tracking problem.

Call me at the clinic or email me directly and I'll see if i can help figure it out.

Sorry can't help more than that at the moment.

Brad
(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Brad,
I had a nueroma between middle and 4th joints in my toes, nasty pain like standing on a nail. I fixed it with a ten dollar silicon toe spreader from the chemist. A big thick one like a dumbell in shape. It spread the toes and the joint and took the pressure off! Wow what a difference. I use it in my running shoes... Not sure if yours is the same but I had to just say this as mine was so easy to fix!

Hi James

It does sound a little like metatarsalgia I agree, but if you have high arches and a short big toe it could be a number of other issues too (like a stress fracture or a mortons neuroma!)

You can trial a metatarsal dome in your orthotic (if it doesn't already have one!) speak to your podiatrist who may review your orthotics (especially if they are a little aged!)

It is a common problem with runners and can sideline you if you keep pushing hard. Ice and activity modification would be a good start (and making sure the cushioning system is still working in your runners).

A physio may be able to video your running style in case there is a biomechanical reason for your 2nd toe to be overloaded. Then you can correct the cause.

No magic bullet unfortunately. Let me know how you go.

Brad
(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Sarah

The Achilles tendon in commonly injured if there are biomechanical faults with your running style. It's always worthwhile having your running assessed so that you can be viewed dynamically as well as having a 'static' assessment.

A heel raise often helps in the early stages (or high heels) as this reduces the preload on the tendon during walking.

Ice and activity modification is also important so you are right to back off a little.

Eccentric calf exercises are good to start as soon as the acute pain is over, and research shows that doing these exercises under load and into pain should gain you the best results.

I hope this helps you.

Brad
(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Sue

Pinching pain in the front of your hip/groin region can indicate a hip joint problem.

If it's more uncomfortable laterally over your hip it is more likely to be a gluteal tendon problem.

The treatment and management of both is quite different and so I don't want to advise you as to which way to handle this based upon only what you have told me so far.

I would recommend definitely getting this looked at asap. If the physio has access to real time ultrasound they can scan the hip joint for internal swelling (effusion) of the hip joint quite easily and that can tell you if the joint is affected.

The fact it settles quite quickly is a good thing, but I wouldn't want you to be releasing your hip muscles if you have a hip joint problem.

I'm happy for you to email me directly (bradmcintosh@ssop.com.au) and I'll help where I can.

Brad

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Kim,

Sounds like you may have a bit of tendonitis in one of your hamstrings. The hamstrings bend the knee backwards and are stretched by straightening the leg (as i'm sure you know from a hamstring stretch). The reason the pain reduces once you start running is because you 'flush' some of the inflammation out of the tendon sheath which helps to relieve the pressure and therefor reduces the pain.

The main thing you need to ascertain is why is this happening? A lot of the time our hamstrings are over-active due to poor core strength, altered running posture whilst running or they could just be too tight. It wouldn't be a bad idea to get in and see either one of our physio's in the city or your regular physio to see what we can do to stop the pain coming on. You should ice the painful parts of the knee, start some gentle stretching of the hamstring and perhaps have you shoes/feet checked to see whether they are contributing to the pain at all.

This is just one possiblity as to why you are getting pain in the back and outside of the knee, for a definitive answer (because without a physical examination of your leg it is hard to correctly diagnose the problem) it would be best to get checked out now so you have at least a few weeks to fix the problem and do the half with as little problems as possible.

Hope that helps

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Juan,

This is a bit of a difficult question to answer without seeing you... Calf tears are notoriously bad when it comes to returning to sport and re-injry. We grade tears from 1 to 3, with 1 being only a slight tear that can have you back running within 10-14 days to a grade 3 tear which means that the muscle belly has torn all the way through which is more like 6-8 week recovery. Its good that the pain has settled quite quickly but a muscle tear is like a tear in a ribbon, once it is torn a little it is at risk of tearing further if you dont give it a chance to heal. That you describe a 'stab' in the calf, indicates to me that it is most probably a tear and you should have treatment on it as soon as you can to help with swelling reduction, scar healing and restoration of gait/running if you are to have any chance of getting back into running sooner rather than later.

Sorry not to be more specific, but its really better to be safer than sorry with calf tears as if you dont get them seen to quickly and effectively, they can come back to bite you over and over again.

Let me know if I can help any further

(* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770 or visit www.ssop.com.au)

Hi Erika,

Resting for a few days and continuing to release your TFL and other structures sounds like a good idea. However, there is obviously a reason as to why these structures became tight in the first place. How long have you been having trouble?

Poor use of your glute muscles and a weak core are often the cause of TFL tightness. Generally, you manage ok for shorter distances but then muscle fatigue sets in and the incorrect muscles start to compensate resulting in discomfort for you.

You still have 3 weeks to go before the run and it sounds like you have done the hard work required so far. Now that you have started to taper, it means you will have extra time to work on strengthening the correct muscles!!

If accessible to you, real-time ultrasound imaging of your core muscles can check if they are working correctly and video analysis of your running style will allow you to identify any problems here.

Adjusting any abnormalities found and carrying out a good core and glutes program for the next 3 weeks will definitely help you out on the day.

Don't worry too much about straying from your training program a little for the next few weeks. It's ok to go into the race with a slightly more aggressive taper, as it sounds like your lead up work has been good. The most important thing is to not bring yourself undone with an injury this late in the game.

I hope this helps, and best of luck putting it all together on the day!

Brad

( * this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au)

Hi Jenny,

That does sound difficult. Unfortunately it is hard for me to advise as I'm not quite sure of the location of your ache (central could be towards front, side or middle) and also a little unsure of the movement you are describing. As such it is difficult to know what structure is creating your discomfort.

If you are experiencing an ankle issue, in order to address the joint mechanics, it is important to also look at the soft tissue structures around the foot/ankle (muscle, tendon, ligament). Looking at the strength, balance and overall function of these areas is vital in order to establish how your foot/ankle is behaving under loaded conditions e.g. running. It is also important to look at your overall biomechanics e.g. pelvis, hip, knee to assess whether this is contributing. An experienced physiotherapist may be able to assist in this regard, in addition to observing your running technique.

As a general guide, try considering the surface you are running on (is it uneven ground versus hard ground versus a camber?) and establish whether this may be contributing. Try changing your load i.e. running shorter distance, reduced pace at a comfortable level, and gradually rebuilding.

A trained professional may also be able to also examine your footwear and advise whether this is appropriate. There are taping techniques that could also assist you to enable you to continue running whilst offloading the injured structure (though without knowing, it is difficult to advise here).

I hope this assists you - please let me know if any further queries or concerns.

Brad

( * this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au)

Hi Margaret,

I'm sorry to hear of your injury.

If you have strained your calf you will need to do targeted exercises for the strained muscle which will vary slightly depending on the size and location of your tear (best to chat through with your physio). The exercises will need to target your calf strength and eccentric control (an important part of muscle repair). Endurance is important and you should be aiming to do high repetitions of calf raises, or until the calf fatigues.

As these exercises progress, you should begin to perform them with increased speed (plyometrics) in order to prepare the muscle for quicker activity.

Best to consult with a physio as the individual nature of your injury will determine your ability to return to running. Guidance in the above areas will also be useful.

All the best! Please refer to the information on our website at the address below for further advice regarding muscle injuries.

Brad.

ssop.com.au/common_injuries/body_parts/muscles,_tendons,_ligaments/muscle_strain/tab0010/menu010

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au)

Hi Angela,

It is difficult to say without seeing your knee what structure may have been injured by your run.

It sounds like your run may have stressed a structure of your knee, which has resulted in a patellofemoral joint problem. This could also be the primary problem, and is common to runners. The 'missing muscle' sounds like it is your VMO, which is the inner quadriceps muscle often inhibited in response to knee pain or swelling, particularly of the patellofemoral joint and its associated structures.

This muscle needs specific retraining to ensure it regains appropriate control (timing compared to the outside quadriceps muscle) and strength, so that you do not experience further tracking issues of your patella (kneecap).

An experienced physiotherapist will be able to assess your knee and advise further. Biofeedback may also be used to assess the efficiency of your quadricep muscles. Please see the link for further information on patellofemoral problems - however bear in mind this may only be part of the overall issue. Best to get it checked out because it is likely some exercises in the right areas will point you in the right direction (and assess any other contributing reasons as to why it may have occurred in the first place):

ssop.com.au/.../menu08

Good luck,

Brad

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au)

Hi Trish

Sorry for the late reply, we've been backed up since the running festival!

The question you really want to ask is why is the piriformis working so hard? There is usually a weakness in the deep hip musculature that is resulting in piriformis being overloaded.

You can stretch/massage/dry needle the muscle to relax it but that deals with only the symptoms, not the cause. You would be wise to get the mechanics of the hip checked to see if there are any specific strengthening or control exercises that will reduce the demand on piriformis.

A good physio or sports physician assessment would be apropriate place to start.

Hope this helps

Brad
* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au)

Hi Trish

Wherever you end up going, it's a good idea to check whether they can use RTUS (real time ultrasound) to assess your hip function. This has been pioneered by Dr Allison Grimaldi (physio) based in Brisbane. She might be a good person to start you off, or will have more local knowledge.

Good luck with it

Brad

Hi Carol,

It's a familiar story...sorry to hear it hasn't been settling well. There are a few strategies that you could employ to see if you can get going again, however, if the ankle continues to flare up it might be worth getting in to see a good Sports Physio to get an accurate diagnosis.

You should definitely tape or brace the ankle for all exercise at the moment. The research suggests either strategy will help to prevent another sprain, and can help with managing post-sprain pain and swelling. I like bracing as it's quick, easy and effective.

Secondly, after each exercise session, stick your foot and ankle in a bucket of cold water with ice for about 10-15 minutes.

Choose exercise that is relatively un-weighted initially. Generally speaking, the ankle should tolerate the bike reasonably well, but start gently and build it up slowly. The goal at first is to get some movement and loading back into the ankle, rather than working up a sweat. As your ankle demonstrates that it can handle what you're throwing at it, then you can ramp up to get some cardio benefit. Once you're tolerating this well, try the walk again.

Balance training is the other challenge you should give the ankle. Even if it's just standing on one foot and holding it for 30 secs throughout the day. If you need an added challenge, close your eyes (but be careful not to fall!). This works the proprioceptive system, so you're less likely to sprain it again.

Good luck, and if you continue to have problems as you try to increase your exercise, get in to see someone to establish a diagnosis.

Hope it starts to behave for you!

Brad

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Zoe

If you are having relief from cracking your neck and massage then your neck does need to be considered in the role of your headaches. If you are continually cracking your neck then these joints could be hypermobile (meaning have too much movement). I would suggest that you may benefit from some strengthening for the little muscles that support the neck, just like you may hear about core strengthening for low back pain. This will provide some support for the joints and ligaments in your neck and you may find you won't have to crack your neck so much. As the neck is considered by some as a "trigger" for cluster headaches and migraines, this may also have the effect of lessening the intensity and frequency of your headaches.

Hope this helps

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Annelise

If indeed you have strained your calf muscle then it sounds like you may have just tried to get back into running a bit soon. It depends what grade muscle tear you have done but even the minor tears can take 2 -3 weeks with the larger tears taking up to six weeks and sometimes longer. Before you return to running you want to make sure the strength and range of motion is full and equal to your non injured side. Its good to hear that you have been doing some stretches and strengthening exercises but I think you probably want to be a bit more gradual and keep advancing the strengthening work for a bit longer before you head back running. OF course, due to the fast change of direction that happens in netball this will take a bit more time to return to and you want to make sure you are doing some sport specific exercises before you head back on court.

Good luck

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Kathleen
I would say that the cramping is due to the fact that the walk is uphill when the others aren't. This requires the muscles to work harder. You tend to get cramp as the muscle fatigues and is struggling with the intensity of the exercise. I think you may benefit from conditioning your legs for the hill walk, have adequate carbohydrate and water, stretch those muscle groups before and after with a light warm up and warm down. Whilst you are working on conditioning those legs you may want to make your walk shorter duration or less intensity and gradually build back up again.

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Peter -

At this stage, we have no credible evidence to support the view that weight lifting can stunt growth. In fact, the american college of sports medicine takes a favourable view of weight lifting during adolescent years.

Of course, we wouldn't recommend lifting heavy weights at and early age, or without knowledge of the correct technique and adequate supervision. If you are new to training I would definitely recommend working with a good personal trainer to get started.

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Helene,

Tendinopathies are often difficult condition's to treat because as soon as you feel as though you are getting better and can do more, you try a run or some exercise and are put back a few weeks. The key is to find out the "cause" of the problem and very gradually return to activity over a period of time. The cause in the case of gluteus medius tendinopathy is usually related to poor pelvic, hip and/or core stability.

The role of the gluteus medeus is to keep the pelvis parrallel to the ground as you take the opposite foot off, as in walking and running. If this doesn't happen, your hips start to swing side to side and up/down and you aggravate the tendon further by stretching the muscle and tendon unit every time you walk. This would obviously be amplified if you were carrying a little bit extra weight and even more so if you started to run. It becomes even more complicated when you are trying to lose weight because you obviously need to exercises to do so and if you want to run this will just set up a vicious cycle which can be hard to get out of without the correct advice.

I'm not sure if you have a physio that can go through your Yoga/Pilates exercises with you because these classes are great if you are activating the correct muscles, but can promote incorrect muscle recruitment patterns if you are not. To make the 4km run you need to increase you cardiovascular fitness. This can't be done in Yoga and Pilates but can be done without running initially, like on the bike, in the pool or on a cross trainer at the gym. This will reduce the stress you put on your gluteus medeus tendon and also help you to lose weight at the same time.

You don't have to start off cycling/swimming continuously for hours at a time, just try 5mins with a 1 min rest to start and repeat that 3-4 times, then reduce the rest and increase the time you are exercising for until you can do 30min. Once you reach 30min exercising at an intensity were you feel breathless but can still talk, then you can increase the time you exercise to 35 min and so on. To get back running you need to think of the same type of training but maybe only running for 2 min and rest for 1 min... the progression needs to be much slower to make sure you don't aggravate the tendon.

Cardio/running is only one way to help to lose weight, you need to increase your metabolism by doing some resistance training as well, but thats a whole other topic.

If you haven't got a physio as yet i'd definitely recommend you looking into finding one that can teach you good hip and pelvic control and help you graduate your return to exercise programme. I'm sure you can do the 4km, its just about taking it slow and getting good advice.

I hope that helps and good luck

Geoff (From the SSOP team)

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Martin,

Well done on your running progress and fitness gains. I am sorry to hear of your recent injury.

This is a little difficult to advise without further information and assessment. The region you are referring to - "the lower leg muscle, behind the knee, on the inside", if muscular in nature, could possibly relate to the medial head of gastrocnemius, popliteus or plantaris tendons; any of which may have suffered a strain or overuse. Potentially you mean a little higher in which case it may be one of the medial hamstring tendons/muscles. If it is a muscle/tendon strain it would be important to properly rehabilitate the injured area with a targeted rehabilitation programme, best guided by a physiotherapist.

However, pain in this region may also be related to the joints of the knee (tibiofemoral or patellofemoral), or may be referred from higher structures including the low back/back of thigh/hip or bottom and nerves of this region.

If there is some pain at night it may indicate an inflammatory component or possibly neural irritation.

Feel free to send along more information - such as the aggravating and easing movements/activities, exactly where the pain is and what type of pain (sharp, dull, catching etc.), if there are any noises, instability or giving way of the knee, if you have any other injuries (back/hip etc.) and this may assist in understanding your problem. However it is probably best to have your knee checked out by your local physio who will be able to diagnose properly and set you on the right track.

All the best!

Kerry (Part of the SSOP team)

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au

Hi Elaine,

Apologies that this post was missed - this year's thread is in a different section (please refer to link "http://bit.ly/KVzAtx" as above).

Your left glute and hamstring tightness and soreness could result from several sources. The "numbness" sounds like a neural irritation or impingement which could be related to an impairment at your lumbar spine, pelvis or hip/thigh. Tightness of musculature in this area will affect the tension of the nerve, however other structures including disc, facet joint, pelvic malalignment should be ruled out, as they may require different treatment in order to improve your problem.

I would recommend you head to your closest physio to get it checked out and heed their advice as to whether it would be okay to continue running with your issue.

All the best!

Kerry (Part of the SSOP team)

* this is general advice only. For private, tailored and expert consultation, please contact Sydney Sports & Orthopaedic Physiotherapy on 9252 5770, or visit www.ssop.com.au